Provider Demographics
NPI:1740899038
Name:HAFELY, DIANA ELAINE (RBT, BCABA)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:ELAINE
Last Name:HAFELY
Suffix:
Gender:F
Credentials:RBT, BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1704 NORTH RD SE STE 2
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-2958
Mailing Address - Country:US
Mailing Address - Phone:330-856-4111
Mailing Address - Fax:
Practice Address - Street 1:1704 NORTH RD SE STE 2
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-2958
Practice Address - Country:US
Practice Address - Phone:330-856-4111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-23
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRBT-16-24378106S00000X
OH0-20-10735106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician